Halo traction brace

ABSTRACT

An orthopedic vest having a posterior and anterior portion fastenable at opposite sides of the user and which when fastened applies an inward force toward the sagittal plane of the body of the user. The vest adjustably supports front and rear yokes each having shoulder harness portions which are attachable over the shoulder of the user. Front and rear support rods are also secured to the anterior and posterior vest portion for adjustably securing a halo about the head of the user. Preferably the rods, halo and associated brackets are of a non-ferrous material for compatibility with CT, NMR and X-ray procedures. The halo consists of a ring having opposite temporal sections, a frontal section and a posterior section. The posterior section or loop is preferably elevated for access to the skull portion of the user. The halo receives skull pins at spaced-apart peripheral locations with the skull pins disposed at an angle with respect to the halo so as to be generally normal with the immediately associated skull portion against which the pin impinges.

The present invention relates to a cervical brace for immobilizing thecervical spine. The brace includes a halo for applying traction to thepatient's head which halo is supported from a vest worn about the bodyof the user.

Various devices can be found in the prior art for immobilization ofcervical vertebrae in the treatment of traumatic injury to this area.For example, the early patent to Kroetz, U.S. Pat. No. 1,301,276, showsa support for the correction of malposition of the cervical vertebraehaving an extensible occipital chin support which operates inconjunction with a support about the body of the user.

Later developed apparatus for the immobilization of cervical spinefractures utilized a plaster jacket unit for supporting a halo. Someapparatus incorporated an overhead framework for suspending a halo orother cervical traction frame as is shown in U.S. Pat. No. 2,649,856 toSchmerl. A somewhat similar overhead suspension apparatus for adjustablyimmobilizing a patient's head in a predetermined position while treatinga fracture or dislocation of the cervical spine is shown in U.S. Pat.No. 3,336,922.

More recent approaches to the problem of treating cervical traumautilize suspension consisting of a stainless steel halo ring which ispositioned around the head of the patient and is attached to the skullby means of skull pins inserted through threaded holes in the halo ring.Axial adjustment of the pins changes the position of the patient's headrelative to the spine so that the proper alignment can be achieved. Thehalo ring is generally supported by a frame arrangement extending from avest worn about the body of the user. U.S. Pat. No. 3,957,040 shows acervical brace which includes means for pivotally connecting spacedlocations on a shoulder-embracing support to three spaced matinglocations on the head-embracing portion of the brace.

U.S. Pat. No. 4,541,421 shows another halo fixation system utilizing anorthopaedic jacket with an attached halo assembly. The halo fixationsystem includes ball and socket assemblies which support the halo foradjustment. The jacket includes a front and rear portion conforming tothe body with straps and locking buckles for adjustably securing thejacket about the patient's waist.

While the foregoing cervical traction apparatus are effective toimmobilize and treat cervical spine fractures, certain disadvantagesexist with such devices. Many of the devices are not compatible withcurrent X-ray, CAT Scan and NMR medical procedures. Further, the idealcervical traction of the halo type should be easy to apply and shouldprovide a full range of adjustment. Further, prior art vestconfigurations for supporting the halo are often uncomfortable for thepatient to wear as they apply pressure to the user's body resulting indiscomfort which can be corrected only by cutting or re-molding thevest. Prior art halo assemblies utilizing a vest often severly restrictthe freedom of movement of the user and require special equipment andspecial hospital procedures to apply the halo and vest. Further, thedesign of conventional halo rings often is not compatible with the shapeof the user's head and, accordingly, the resulting orientation of theskull pin does not provide optimum securement of the pins to the skull.

Accordingly, there exists a need in the prior art for improved cervicaltraction device of the type utilizing a skull-encircling halo supportedfrom a torso-encircling vest which device is compatible with medicalX-ray, CAT scan and NMR procedures and which is convenient and efficientfor application and which provides the wearer freedom of movement andcomfort.

Accordingly, it is a primary object of the present invention to providea halo support vest which is compatible with the anatomy of the wearerand which exerts a securing force toward the sagittal plane of the body.

Another object of the present invention is to provide a halo ring whichbetter conforms to the shape of the skull of the user for bettersecurement of the skull pins.

Still another object of the present invention is to provide a halofixation system which is modular, lightweight and which utilizesstate-of-the-art materials.

A further object of the present invention is to provide a halo fixationsystem which is easily utilized by medical personnel and which is easilyfitted and adjusted to apply traction, angulation, rotation, andtranslation procedures.

A more complete understanding of the present invention will be had fromthe following description taken in conjunction with the accompanyingdrawings in which:

FIG. 1 is a perspective view of the vest portion of the halo fixationsystem of the present invention;

FIG. 2 is a side view showing a patient's head and upper body in dottedlines with the halo and supporting structure in position;

FIG. 3 is a perspective view of a skull pin;

FIG. 4 is a perspective view of the neck support as indicated in FIG. 2;

FIG. 5 is a top view of the neck support shown in FIG. 4;

FIG. 6 is a plan view of the halo ring shown in FIG. 2;

FIG. 7 is a front view of the halo ring shown in FIG. 6;

FIG. 8 is an sectional view of the halo ring taken along lines 8--8 ofFIG. 6;

FIG. 9 is a perspective view of the halo ring and attachment assembly;

FIG. 10 is an exploded view of the assembly for securing the halo ringto the attachment rod as seen in FIG. 9;

FIG. 11 is a detail view of the universal connection at the front of thevest as seen in FIG. 1;

FIG. 12 is a sectional view taken along line 12--12 of FIG. 1;

FIG. 13 is a detail view as indicated in FIG. 12;

FIG. 14 is a sectional view taken along line 14--14 of FIG. 1;

FIG. 15 is a sectional view taken along line 15--15 of FIG. 1;

FIGS. 16, 16A are sectional views of the vest buckle assembly asindicated in FIG. 1 with the buckle in a closed position in FIG. 16 andan open position in FIG. 16A;

FIG. 16B is a detail view of the adjustable clasp portion of the buckleassembly shown in FIGS. 16 and 16A;

FIG. 17 is a sectional view taken along line 17--17 of FIG. 1;

FIG. 18 is an exploded perspective view of an end portion of the vestshown in FIG. 17;

FIG. 19 is a sectional view taken along line 19--19 of FIG. 1;

FIG. 20 is a sectional view taken along line 20--20 of FIG. 1;

FIG. 20A is a sectional view of the tongue and buckle shown in FIGS. 19and 20 in an engaged position;

FIG. 21 is a detail of the support bar shown in FIG. 1;

FIG. 21A is a view of the support bar as shown in FIG. 21 with thelocking sleeve in an extended position;

FIG. 22 is a perspective view of an alternate support bar arrangementutilizing non-ferrous materials;

FIG. 23 is an exploded view of the support bar arrangement of FIG. 22;

FIG. 24 is a sectional view taken along line 24--24 of FIG. 22;

FIG. 25 is omitted.

FIG. 26 is a detail view illustrating an alternate arrangement foradjustably securing the skull pin to the halo ring;

FIG. 26A is a sectional view taken along line 26A--26A of FIG. 26;

FIG. 27 is a sectional view taken along line 27--27 of FIG. 26A;

FIG. 28 is a perspective view of the upper anterior portion of the vestin conjunction with an optional chin support;

FIG. 29 is a perspective view of the chin support shown in FIG. 28;

FIG. 30 is a perspective view of an optional halo ring and temporarytraction support;

FIG. 31 is an exploded view of the tong attachment assembly shown inFIG. 30;

FIG. 32 is a side view of another embodiment of the halo;

FIG. 33 is a sectional view taken along line 33--33 of FIG. 32;

FIG. 34 is enlarged view as indicated in FIG. 32 34--34 of FIG. 32;

FIG. 35 is a plan view of the halo shown in FIG. 32;

FIG. 36 is a perspective view of another halo and traction support;

FIG. 37 is a plan view of the halo shown in FIG. 36;

FIG. 37A is a sectional view of the halo shown in FIG. 37;

FIG. 38 is a sectional view taken along line 38--38 of FIG. 36;

FIG. 39 is a sectional view taken along line 39--39 of FIG. 37;

FIG. 40 is a sectional view taken along line 40--40 of FIG. 37; and

FIGS. 41 and 42 show an alternate arrangement for securing the loop tothe halo ring.

Turning now to the drawings, FIG. 1 illustrates the vest portion of thecervical brace and fixation system of the present invention. The vestmay be used to support halo rings of various construction and theindividual halo ring construction will be more fully describedhereafter. The vest is generally designated by the numeral 10 andincludes a front or anterior portion 12 and a rear or posterior portion14. The front vest portion 12 is preferably molded from a syntheticmaterial such as polyethylene or polyurethane and has belt 16 generallyextending across the upper abdominal area of the user terminating atopposite ends 18 in the area of the external oblique muscle. Bracket 20is supported by belt 16 in an area generally corresponding to the upperabdominal area of the user to provide vertical adjustment for the frontshoulder yoke as will be more fully explained hereafter. As seen inFIGS. 1 and 12, bracket 20 defines a vertically-extending centralchannel 22 which is provided with flanges 21 at opposite sides toslidably receive lower tongue end 24 of the yoke assembly 25.

Vertically extending slots 26 are in registry with apertures 27 in theyoke portion 25 to provide vertical adjustment of the yoke assemblyrelative to the belt 16. A plurality of fastener assemblies eachconsisting of bolt 30, washer 31 and nut 32 extend through aperture 27and slots 26 as best seen in FIGS. 1 and 13. Thus, the vertical positionof yoke assembly 25 can be adjusted by loosening bolts 30 and adjustingyoke assembly 25 relative to bracket 20 and thereafter tightening bolts30 to secure the yoke assembly at the desired position

Vest 10 also includes a posterior belt portion 35 extending oppositelyfrom posterior portion 40. Posterior belt portion 35 is adjustablysecurable to belt 16 at buckle members 41 which are hinged or pivotallysecured to belt 16. Buckles 41 are shown in detail in FIGS. 16, 16A and16B, have an over-center lever 42 and are provided with a plurality ofnotches 43 which engage one end of bail 44 at a selected position. Bail44 extends through an aperture 45 with the opposite end of bail 44engageable about a hook 46 on belt portion 35. FIG. 16 shows a buckle 41in a closed position with the lever in an over-center position. Multiplebuckle assemblies may be provided at either side for more precise andbetter adjustment. By selectively engaging bails 44 at the appropriatepost 46 at one end and a selected notch 43 on the lever 42 at the otherend, precise circumferential snugness of the vest may be obtained. Thebuckle is opened as shown in FIG. 16A by pivoting lever 42 to releasethe bail. The belts 16 and 35 are preferably about four to six inches inwidth and are suitably flexible to conform to the anatomy of the user.The lower edge of anterior portion 12 is provided with a central cut-out50 to relieve pressure in the area of the diaphragm of the user.

Posterior vest portion 14 has opposite sections 52 which extend acrossthe back of the user in the lower thoracic area. Side sections 53 arejoined to the rear sections 52 by fasteners 55 which extend throughholes 58 at opposite edges of rear belt portion 52 as shown in detail inFIG. 15. Additional circumferential or girth adjustment can be obtainedby selectively positioning fasteners 55 in the desired openings 58 inthe belt. A principal advantage is that the belt arrangement describedabove allows the vest to be tightened laterally inwardly toward thesagittal plane of the body thus relieving pressure to the abdominal anddiaphragm areas occasioned by conventional vest closure arrangements.

As seen in FIGS. 1 and 14, tongue 60 extends vertically from the rearcentral area of posterior vest section 14 and is received within bracket62 carried on the lower end of the rear shoulder harness 48. Tongue 60has a central vertical projection 65 received within a recess 67 inharness 48 to guide the relative vertical adjustment between these twocomponents. The components can be secured within the range ofadjustments by fasteners 66. The overall construction of the adjustablebracket 62 generally corresponds to that of bracket 20 described aboveand further detailed discussion is not believed necessary.

Front transverse reinforcing bar 80 is attached by appropriate rivets orother fasteners 82 to anterior yoke assembly 25. The opposite ends ofbar 80 each carry a U-shaped bracket 84 which is secured to the bar bybolt 85. The lower end of frontal support bar assemblies 101, 102 eachare provided with inwardly turned leg 104 which is received withinbracket 84 and which may be laterally adjusted with respect to bracket84 and secured in the desired position. A pair of anterior shoulderharness members 110 and 112 are secured to yoke 25 and joined theretoabove transverse support bar 80. Referring to FIG. 11, it will be seenthat the lower ends of each of the anterior shoulder harness members110, 112 terminate at a socket 114 which receives the curved surface ofsemi-spherical ball 116. L-shaped bolt 118 is secured to the outerplanar surface of balls 116 having threaded end 120 which is receivedwithin bore 121 at the terminal end of the bracket 80 A collar 122 isprovided on the shank of the bolt so that the bracket and bolt may besecured by nut 125. Ball 116 can be moved horizontally, vertically orrotated within the socket 114. Accordingly, each of the harness members110, 112 which extend over the shoulder area and down the trapeziusmuscle of the wearer may be adjusted to fit the anatomy of the user,particularly providing adjustment in the deltoid pectoralis major musclearea.

The distal or outer ends of the harness members 110 are each providedwith a tongue 130 having a plurality of transversely extending grooves132 on one surface of the tongue. The tongues are adjustably receivablewithin buckles 135 secured to the upper end of strap portions 136 and137 at opposite sides of the posterior portion 40. It will be seen thatharness members 110 and 112 are securable to the 7 corresponding rearstrap 136 and 137 at buckle and tongue 130 and 135, respectively. Thegrooves 132 are selectively engageable with the buckle to provide lengthadjustment as is shown in detail in FIGS. 19, 20 and 20A.

A support bar 140 extends transversely across the rear vest section 48at a location above the projection of the scapula. For comfort, theopposite ends of the bar may be rearwardly recessed away from the bodyof the user. Bar 140 is secured to the yoke 48 by appropriate rivets orother fasteners 142. Each end of the bar 140 carries a clamp 145 whichis secured to the bar by a fastener 146 as best shown in FIGS. 1, 17 and18. The clamps 145 accomodate the lower horizontal ends 147 of rearsupport rods 150 and 152. The rear support rods each are constructedhaving a horizontal lower end 147, a vertical section 151, inwardlyconverging section 153 and a upper distal end 154 which is provided withthreads 155 which carry lock nuts 158. It will be seen that the spacingand relative lateral position of the rear support rods 150 and 152 maybe selectively adjusted at clamp members 145 by moving rod sections 147relative to clamps 145.

The front support rods 101 and 102 are best seen in FIGS. 1, 2, 21 and21A and each have horizontally, inwardly turned lower leg 104,vertically extending section 160 and an intermediate angular section 162which extends inwardly toward the wearer forming an acute angle withrespect to section 160. A second section 164 is axially aligned withsection 162 and is pivotally connected thereto at pivot connection 165.A cylindrical sleeve 170 is slidable along sections 162 and 164 whenthey are axially aligned. With sleeve 170 in the position shown in FIG.21A, pivot connection 165 allows rod section 164 to rotate as indicatedby the arrows for release from the bracket 174 secured at section 154 onthe corresponding rear rod as seen in FIG. 2. When the sleeve 170 ismoved downwardly as shown in FIG. 21, sleeve 170 serves to lock supportsections 162 and 164 in axial alignment.

The foregoing description relates to the vest and rod support portionsof the halo fixation system. A preferred embodiment of the halo isillustraated in FIGS. 6 through 10. The halo assembly consists of a haloring 175 and bracket assembly 181 secured at opposite lateral sides ofthe halo and attachable to the upper vertical ends 154 of support rods150 and 152. Halo 175 consists of opposed pair of lateral or temporalsections 176 and 177, a posterior superior loop 180 and anterior segment182 all integrally joined to form the halo. The posterior loop 180extends to the area of the parietal bone to provide medical personnelaccess to the rear of the skull for medical treatment. The oppositetemporal sections are generally horizontally disposed when in position.The anterior segment 182 is disposed at an angle of approxiamte 12° withrespect to the lateral segments 176 and 177 as best illustrated in FIG.8. A plurality of threaded bores 183 are provided at spaced locations inthe halo, generally perpendicular to the outer surface of the halo ring.Thus, when skull pins 185 as shown in FIG. 3 are placed in the bores183, particularly in the frontal segment 182, the pins will assume aposition generally perpendicular to the area of the skull immediatelyadjacent the ring with the threaded body portion 186 of the pin engagingthreaded bores 183 in the halo. The point 188 of the pin is brought intocontact with the patient's skull and is generally perpendicular thereto.Since the frontal bone curves inwardly and rearwardly in the areagenerally encompassed by halo anterior segment 182, the point 188 of thepins in the frontal area will engage the halo skull to better secure thering without slipping or damage to the skin of the patient. Similarly,the pins located in the lateral and posterior halo section will alsoengage the skull for better securement reducing the possibility ofslippage.

The halo 175 is secured at opposite temporal sections 176 and 177 by apair of bracket assemblies 181 disposed at the upper end of each of therear support rods 150. The bracket assembly 181 is best seen in FIG. 10.The rear support rods 150, 152 are threaded at their upper ends andadjusting nut 158 is in threaded engagement with the rod. Clamp 192defines a vertical bore 194 which receives the upper end of rods 150,152. Threaded bore 196 extends transversely with respect to verticalbore 194. Radial star teeth 195 are provided about the bore 196 topermit angular adjustment of angle bracket 200. Angle bracket 200 hasperpendicular legs 202 and 204 provided with bores 206 and 208,respectively. Leg 202 is provided with radial star teeth 210 which areengageable with teeth 195 on bracket 192 to provide angular adjustmentbetween the two elements. Bolt 212 extends through leg 202 engagingthreaded bore 196 of bracket 192 to secure the angle bracket and clamp192 together and further to secure the clamp at the proper height aboutthe upper end 155 of the rear rods. The opposite leg 204 of the anglebracket is provided with radial star teeth 226 which are engageable withteeth 230 on adapter 232. Adapter 232 is provided with a bore 234through which bolt 215 passes to engage a selected threaded bore 183 inthe halo 175 as best seen in FIG. 2. The inner surface of adapter 232defines a slot 236 so that the adapter will engage the opposite edges ofthe halo member and not rotate relative to the halo ring. The frontsupport rods 101 and 102 are attached to the rear rods at bracket 174 asseen in FIG. 2.

Thus, it will be seen that with the adjustments provided at the halovest, the vest can be efficiently and comfortably fitted to patients ofvarying anatomical sizes and shapes. The vest being of a soft syntheticmaterial is flexible but yet provides stability for the superjacenthalo. The belt portion of the vest which extends around the torso of theuser may be selectively tightened so that the belt tightens laterallyinwardly toward the saggiatal plane relieving pressure in the area ofdiaphragm.

FIGS. 26, 26A and 27 show an alternate arrangement for attaching theskull pins to the halo ring 262 so that they may be properly positionedrelative to the skull. In this embodiment vertically elongated slots 240are provided at spaced apart peripheral locations in the halo ring 262.Adjacent the opposite edges of slots 240, trunions 242 and 244 areintegrally formed with the halo ring. Each trunion 240, 242 defines athreaded bore which receives studs 246 and 248 which oppositely extendfrom cylindrical body member 250 positioned between the trunions. Theends of the studs 246, 248 each are in threaded engagement with nuts251. The outer ends of each of the studs are provided with a recess 252for receipt of an Allen wrench or similar tool.

A transverse threaded bore 255 extends through body member 250 inalignment with slot 240 in the halo. Skull pin 260 is in threadedengagement in threaded bore 255 as best seen in FIG. 26. The inner endof the skull pin is provided with a pointed end 261 for engagement withthe patient's skull as is conventional.

It will be apparent that the angular position of the skull pin relativeto the skull can be adjusted by rotating the body member 250 on studs246, 248. When the desired angular position is obtained, the body member250 can be locked in place by tightening nuts 251 securing the studsfrom rotation by insertion of an Allen wrench or similar tool in recess252. Skull pin 260 can then be advanced or retracted in bore 255 untilthe point is in proper engagement with the patient's skull preferablygenerally perpendicular to a tangent to the skull at that location.

Another embodiment of the halo ring is illustrated in FIGS. 32 to 35.This embodiment is generally designated by the numeral 280 and the haloring 282 is generally configured as has been described with reference tothe previous figure having an elevated posterior section 284, oppositelateral or temporal sections 285 and a frontal segment 286 to generallyconform to the shape of the human skull. Bosses 290 are integrallyformed at spaced apart locations on the frontal and posterior halosection. Bosses 290 are provided with threaded bores 292 as best seen inFIG. 34. The bores 292 in the frontal area are angularly disposed withrespect to the lower edge surface of halo segment 282 so that the skullpins when inserted will engage the adjacent portion of the skull in agenerally normal position. The angular disposition of the bores 292 willvary with the position of the bore on the halo ring. For example, in thenormal skull configuration, bores 292 at the frontal section willgenerally be angled upwardly between 0° and 12° as seen in FIG. 34. Thethreaded bores 292A in the posterior segment of the halo ring asindicated in FIG. 33 are preferably downwardly angled 10° to 12° forbest pin engagement with the skull. The bosses and bores in the oppositetemporal sections 285 will be generally perpendicular to the inner sideof the halo. The angularity of the bores is selected so that the pinsengage the skull in a generally perpendicular orientation.

Another significant advantage of the present invention provides for ahalo support system which is compatible with computer tomography (CT),nuclear magnetics resistance (NMR), and X-ray techniques. In many cases,the use of stainless steel or other ferrous material interferes withthese medical procedures and use of alternate materials such as nylon,plastics, hardcase aluminum and titanium is preferable. Accordingly,FIGS. 22 to 25 illustrate an alternate construction for the rear supportrods which utilize primarily non-ferrous materials. In this case, theassociated halo is preferably constructed from non-ferrous material suchas hardcase aluminum or a carbon graphite material. The problem withmany non-ferrous materials, particularly nonmetallic materials such ascarbon graphite, is the difficulty of attaching brackets and othermounting hardware to the rods as these materials are not suitable forplacement of threads. Accordingly, as shown in FIGS. 22 to 24, the halosupport rods are formed of a suitable nonferrous material such as nylon,fiberglass or carbon graphite and are designated by the numeral 300. Athreaded non-ferrous tube 302 is engageable over rod 300. The lower endof tube 302 is provided with a longitudinally extending slot 304. A locknut 305 is engageable about the threaded tube 302. The threaded tube 302may be positioned at any suitable axial position along rod 300 and nut305 tightened causing the rod in the area of the slot 304 to tightlyengage rod 300. Adjustable sleeve 310 has an integrally formed lock nut312 at its lower end in threaded engagement with tube 302. Preferablysleeve 310 and lock nut 312 are of a suitable nonmetallic material suchas plastic or nylon. The upper end of sleeve 310 supports clamp 330which has a threaded member 322 with longitudinal slots 230 whichdefines an axially extending bore 325 which is slidable over the upperend of rod 300. Clamp 330 includes a pair of opposed faces 326, 327having radially extending star grooves or teeth therein which areengageable either with an adapter 331 having a recess 332 engageablewith the halo 175. In the alternative, the grooved star surfaces 326 and327 may be engageable with a corresponding surface 335 directly formedor molded in the surface of halo 175A. A bolt or other appropriatefastener, not shown, may be extended through bore 342 in clamp 330 tosecure the bracket to the halo at threaded bore 183 or 183A. Lock nut350 is in threaded engagement with threaded section 322 of the clamp 330to compress section 322 about rod 300 and secure the clamp in thedesired position. With the construction described above, the use offerrous materials which would interfere with certain medical proceduresdescribed above is minimized. Further, the construction allows fullvertical adjustability of the halo through adjustment at tube 302 andsleeve 310. Angular adjustment is obtained at clamp 330 which may berotated about threaded section 322 and locked in position by nut 350.

As seen in FIG. 2, the front support bars are connected to the rearsupport bars at bracket 174. As has been described above, the frontsupport bars are provided with a locking sleeve 170 which, when movedupwardly, allows the front support bars 101 and 102 to be quicklydisengaged from the associated rear bar. The front support bars connectto the rear support bars in an area generally corresponding to thesteronciedomastoid muscle. As best seen in FIGS. 2, 4 and 5, arearwardly extending bracket 375 is in threaded engagement with theupper section of rear support rods 150 and 152. The brackets 375 definea horizontal bore 376 for receipt of support rod 378 having an off-setcentral section 380. A neck brace or pad 382 is secured to the off-setrod section by a clamp 384. The brace is preferably padded andtransversely curved to conform to the anatomy of the user in this area.As best seen in FIG. 4, it will be seen that the relative forward andrearward position of the pad 382 is adjustable by rotation of the rod378. In addition, pad 382 is also rotatable about the axis of recessedcentral portion 380 of support rod 378 to provide additionaladjustability in accordance with the physical requirements of thepatient and the requirements of the treatment.

In some medical situations, a patient recovering from a cervical injurycan, after sufficient time in the halo, have the halo removed withsufficient cervical stability provided by non-invasive mandible andoccipital supports. The present invention is modular in that variouscomponents may be removed and replaced by other components as dicated bythe medical treatment. As shown in FIGS. 28 and 29, modular mandible andoccipital supports can be utilized with the vest portion of the presentinvention. The upper front portion of the vest is a yoke assemblyindicated by the numeral 5 and is as has been more fully described inFIG. 1. The bracket 20 defines a vertically extending channel 22 whichhas a slot 400 which removably receives tongue 402. The upper end oftongue 402 defines a clevis 406 having a threaded rod 408 in engagementwith internally threaded sleeve 410. The upper end of sleeve 410 is inthreaded engagement with member 412 which is pivotally secured to theunderside of support 420. Support 420 is generally curved to conform tothe configuration of the mandible portion of the anatomy. Suitablepadding 425 may be provided on the interior surface and straps 426 maybe secured to the support for attachment about the head of the user tofurther restrain the cervical area from undesirable movement. Thevertical position of the support is adjusted by rotating sleeve 410 toextend or shorten the effective overall length of the support.Similarly, the clevis arrangements at either end of sleeve 410 allow forforward and rearward adjustment of the support.

In FIG. 29 a support for the occipital area is provided which is similarin construction to the mandibular support having a head-engaging shell440 generally conforming to the shape of the posterior portion of thecranium. The shell 440 is secured to a tongue 445 through a clevisarrangement 446 on the support which, in turn, is engageable within anelongated threaded nut 449. Clevis 446 on the tongue 445 also pivotallysupports a threaded rod 448 which is in threaded engagement with thelower end of the threaded nut 449. Tongue 445 is supported at slotformed as a part of recess 67. A full range of adjustments can beobtained in accordance with the requirements of the user and the medicaltreatment to support and restrain the user's head.

In some medical situations, tongs will be used initially because oftheir ease of application in emergency treatment procedures. It is oftennecessary to initially use a bail or temporary loop for traction. Thehalo ring of the present invention is useable with tongs and a temporarybail or loop for traction. The tongs and bail can be removed whendesired leaving the halo in position which halo can then be secured tothe head of the user by skull pins. Thus, the medical attendant does nothave to decide whether he or she initially wishes to use traction astraction can be accomplished through a temporary loop attachable to thehalo ring. Similarly, Crutchfield tongs or other tongs can be initiallyused with the halo ring and removed from the halo ring leaving the ringin place ready for securement to the patient making the transition muchmore efficient and less traumatic to the patient.

FIGS. 30 and 31 show a modified halo ring generally designated by thenumeral 500 and which includes a continuous halo ring 502 havingopposite temporal sections 504, frontal loop 506 and posterior loop 508.Tapped bores 510 are provided at spaced-apart locations in the halo. Ashas been described with reference to the preceding embodiments, thebores 510 are oriented so that skull pins placed in the holes will begenerally normal to the user's skull for better engagement. Temporarytongs 520 may be used with the halo ring and removed after initialemergency procedures have been completed. The tongs 520 are ofconventional design such as Crutchfield tongs or other tongs well knownin the medical field. The tongs are secured to the halo by a bracket 525which is securable to the halo at threaded holes 528 which can bepositioned to align with selected tapped holes 510 in the temporalsections of the halo ring. Appropriate fastener 530 secures the brackets525 to opposite sides of the halo ring. Bracket 525 defines a circularopening having teeth 534 about its interior. Teeth 534 engage externalteeth 536 on bushing 540. A flange 542 on bushing 540 engages the innersurface of the bracket. The tong assembly 520 includes a skull pin 545having a threaded body which engages cooperating internal threads inadjusting members 550, 552 and bushing 540. Thus, pins 520 can beadvanced or retracted by rotation in the appropriate direction once thedesired position is achieved, may be locked in place by tighteningadjusting nut 552. As is conventional, one of the opposed tongs may bespring loaded in order to achieve proper application of force.

Temporary bail or loop 560 may be supported from ring 565 having atoothed circular opening 568 engageable on the exterior 536 of bushing540. Ring 565 includes an upwardly extending bracket 570 having a bore572 therein. The inner face of bracket 570 is provided with star teeth575 which cooperates with similar star teeth 580 on the lower end ofbail or loop 560. Thus, the relative angular position of the temporaryloop 560 relative to the halo 502 can be adjusted and when the desiredposition obtained, the loop 560 secured in place by fastener 586extending through bore 572 into threaded bore 588 at the end of theloop. The loop 560 may further be provided with an eye bolt 590 at theapex of the loop for attachment to an external traction system.

FIGS. 36 to 40 illustrate another embodiment of a halo adapted for usewith tongs and a temporary support loop. The halo is generallydesignated by the numeral 500 and has a separate anterior segment 505and posterior segment 504 which are joined at opposite temporal sectionsby bracket 508. Bracket 508 has a body 510 with a bore 512 adapted toreceive conventional tongs, not shown. Arms 514 and 516 extendoppositely from body 510 and define bores 520 which align with elongatedslots 522 in the ends of the halo segments. Fasteners, not shown, areused to secure the halo segments to bracket 508 in the desired position.

Temporary loop 528 is semi-circular and extends between brackets 510 andis securable thereto at feet 530 by a bolt or other fastener engageablein bores 526.

FIGS. 37, 37A and 38 to 40 illustrate the segmented halo with integrallyformed bosses 530, 532, 534 having angularly disposed bores 540, 542 and544, respectively, to accomodate skull pins as has been described above.

FIGS. 41 and 42 illustrate another construction for attachment of atemporary loop 550 which terminates at feet 552 having holes 553therein. Feet 552 are adjustably securable to base 555 which defines aslot 558 alignable with bores 553. A fastener, not shown, is utilized tosecure the components. Base 555 includes a flange 560 defining a bore562 which is securable at bore 526 in member 510.

With the embodiment of FIGS. 37 to 42, the patient may first be placedin traction and critical cervical treatments initiated such asreduction. After initial treatments, the ring is added for additionaltreatments and may be removed leaving the halo in position.

It will be obvious to those skilled in the art to make various changes,alterations and modifications to the system described herein. To theextent these various alterations, modifications and changes do notdepart from the spirit and scope of the appended claims, they areintended to be encompassed therein.

I claim:
 1. A cervical brace to be worn on the upper body forstabilizing and immobilizing the head and cervical spine of a wearercomprising:(a) a flexible anterior belt portion adapted to extend aroundthe lower costal area of the ribs and terminating at either side of thewearer; (b) a flexible posterior belt portion adapted to extend aroundthe lower thoracic lumbar are a of the user and terminating at eitherside of the user; (c) fastener means adjustably connecting said anteriorbelt portion and said posterior belt portion of the sides of the wearerand adapted to apply a closing force generally perpendicular withrespect to the sagittal plane of the body of the wearer; (d) frontbracket means on said anterior belt portion in the region of the sternum(e) rear bracket means on said posterior belt portion in the lumbarspinal area; (f) front yoke means carried on said front bracket meansand being vertically adjustable relative to said front bracket means;(g) rear yoke means carried on said rear bracket means and beingvertically adjustable relative to said rear bracket means; (h)adjustable strap means extending between said front and rear yoke meansadapted to extend over the shoulder of the wearer; and (i) a pair offront support rods having upper and lower ends and attached at theirlower ends of opposite sides of said front yoke means and a pair of rearsupport rods having upper and lower ends and attached at their lowerends at opposite sides of said rear yoke means, said front and rearsupport rods adapted to support a halo at their upper ends.
 2. Thecervical brace of claim 1 wherein said strap means are joined to saidfront yoke means at a pivotal connection on said front yoke means, saidpivotal connection being located in an area substantially conforming tothe deltoid pectoral groove of the wearer.
 3. The cervical brace ofclaim 1 wherein said front yoke has mounting means associated therewithand further including mandibular support means adjustably received insaid mounting means.
 4. The cervical brace of claim 1 wherein said frontsupport rods include a pivotal joint and locking means for securing saidrods in a locked position wherein said rods may be unlocked and pivotedto an unlocked position.
 5. The cervical brace of claim 1 furtherincluding removable occipital support means adjustably securable at saidrear yoke means and adapted to supportingly engage the head of the user.6. The cervical brace of claim 1 wherein said support rods arenon-ferrous and wherein said front support rods are secured to said rearrods at an intermediate position on said rear rods and wherein said rearrods support an axially extending nonferrous sleeve selectivelyengageable on said rear rods and further including halo bracket meansadjustably carried on said sleeve.
 7. The cervical brace of claim 1wherein said flexible anterior belt portion defines a relieved areagenerally conforming to the diaphragm of the wearer and wherein saidflexible belt anterior and posterior portions are fabricated from apliable material.
 8. The cervical brace of claim 1 further including ahalo ring adapted to fit around the head of the wearer and attachable tothe skull by means of adjustable skull pins and supported on said frontand rear support rods.
 9. The cervical brace of claim 1 wherein saidfront and rear support rods are transversely adjustable relative totheir said respective yoke means.
 10. A halo traction device formounting skull pins useable with tongs and supportable on support rodsattached to an orthopaedic vest worn by the user comprising:(a) a haloring adapted to fit around the skull of the wearer and supportable byrods extending from an orthopaedic vest worn about the body of the user;and (b) said halo ring having opposite temporal sections, an anteriorloop, and a posterior loop, said halo ring including threaded bores atspaced-apart predetermined locations around said halo ring, said boreshaving an axis selected to orient the skull pins therein a predeterminedlocations generally normal to the point of contact with the adjacentskull portion with respect to the circumferential and upward curvatureof the cranium.
 11. The halo traction device of claim 10 wherein saidanterior loop is elevated relative to the temporal sections to provideaccess to cranium area of the user.
 12. A cervical brace to be wornabout the upper body of a user for supporting a head-engaging halo atsupport rods for stabilizing and immobilizing the head and cervicalspine of the wearer, said brace comprising:(a) an anterior belt portionadapted to extend around the front of the user in the lower costal areaof the ribs and terminating at either side of the werer and having afront portion extending upwardly in the region of the sternum; (b) aposterior belt portion adapted to extend around the back of the user inthe lower thoracic lumbar area and terminating at either side of theuser at a location spaced-apart from said anterior belt, said posteriorbelt having a rear portion extending upwardly in the thoracic region;(c) fastener means interconnecting said anterior belt portion and saidposterior belt portion at either side of the wearer and adjustable toapply a closing force having a component generally perpendicular withrespect to the sagittal plane of the body of the wearer; (d) frontsupport means on said front portion of said anterior belt and beingvertically adjustable relative thereto and having first bracket meanstherein for attachment of front halo support rods; (e) rear supportmeans on said rear portion of said posterior belt and being verticallyadjustable relative thereto and having second bracket means thereon forattachment of rear support rods; and (f) adjustable strap meansextending between said front and rear belt portions over the shouldersof the wearer.
 13. A halo traction device for mounting skull pinsuseable with tongs and supportable on support rods attached to anorthopaedic vest worn by the user comprising:(a) a traction ring adaptedto fit around the skull of the wearer and supportable by rods extendingfrom a vest about the body of the user; and (b) said halo ring havingopposite temporal sections, an anterior loop, and a posterior loop, saidhalo ring including threaded bores at spaced-apart predeterminedlocations around said halo ring, said bores having an axis selected toorient the skull pins therein at predetermined locations generallynormal with respect to adjacent skull portion; and (c) said temporalsections being bifurcated and adapted to be connected by bracket meansto receive said tongs therein.
 14. The halo traction device of claim 13further including means associated with said bracket means fordetachably securing a transverse loop extending between said oppositetemporal sections.
 15. A halo for peripheral fixation about the head ofa user and supportable upon rods from an orthopaedic jacket, said halocomprising a ring having opposite temporal sections, an anterior sectionand a posterior loop section, said loop section defining slots thereinat spaced-apart peripheral locations, boss means adjacent said slotmeans and rotatively supporting body means defining a threaded boretherein alignable with said slot means and pin means having a pointedend and in threaded engagement in said bore and axially adjustable withrespect to said bore and means for locking said body means in apredetermined angular relationship with respect to said halo to positionsaid pin means relative to the head of the user.